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Adherence to inhaled corticosteroids in children: Too much to ask?

Published Online: November 21, 2011

Inhaled corticosteroids form the cornerstone of asthma therapy in patients with persistent asthma. While it is known that adherence to therapy is often incomplete, the long-term effects of different levels of adherence to inhaled corticosteroid therapy on efficacy and safety endpoints are unclear.

In a recent issue of The Journal of Allergy & Clinical Immunology, Krishnan et al report results of an ancillary adherence study within the Childhood Asthma Management Program (CAMP). CAMP was a large multi-center placebo-controlled clinical trial designed to evaluate the long-term effects of inhaled budesonide, a corticosteroid, in children five through twelve years of age with mild or moderate persistent asthma. This ancillary study was conducted in three of eight CAMP clinical centers. The researchers compared children's adherence to therapy based on self-reported data (daily diaries) and compared it to objectively measured data (number of doses left in study inhalers) over a four-year study period. High level of adherence was defined as objectively measured adherence averaged over the four-year study period of at least 80%. The researchers determined if objectively measured adherence to study medications modified the effects of inhaled budesonide compared to placebo on clinical, pulmonary function, height and bone mineral density endpoints.

The study included about 150 children. Only about a quarter of children had high levels of adherence to study medications, whereas self-report suggested more than 90% did. Adherence was similar in the budesonide and placebo groups. In children with high levels of adherence to study medications based on objective measurements, inhaled budesonide improved FEV1 compared to placebo. Similar benefits on lung function were not observed in children with lower levels of adherence. Adherence did not appear to modify the long-term effects of inhaled budesonide on other endpoints.

The authors' findings indicate that high levels of adherence to inhaled corticosteroids may be difficult to achieve in long-term studies. The effects of different levels of adherence to inhaled corticosteroid therapy on long-term efficacy and safety endpoints in CAMP were inconsistent.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.